Provider Demographics
NPI:1164729224
Name:KASTURI, AVINASH (MD)
Entity Type:Individual
Prefix:
First Name:AVINASH
Middle Name:
Last Name:KASTURI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:AVI
Other - Middle Name:
Other - Last Name:KASTURI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:8816 JERICHO CITY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH ENGLEWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20785-4762
Mailing Address - Country:US
Mailing Address - Phone:703-674-9990
Mailing Address - Fax:
Practice Address - Street 1:8816 JERICHO CITY DR
Practice Address - Street 2:
Practice Address - City:NORTH ENGLEWOOD
Practice Address - State:MD
Practice Address - Zip Code:20785-4762
Practice Address - Country:US
Practice Address - Phone:703-674-9990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-24
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0076555207Q00000X
VA0101252437207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty